Site Mobile Navigation

CLINTON PROPOSES AID FOR DISABLED RETURNING TO JOBS

As part of his budget for the coming year, President Clinton will propose expanding Medicaid and Medicare to allow tens of thousands of people with disabilities to retain their health benefits when they return to work, Administration officials say.

Under current law, many of these people must, in effect, choose between working and keeping their health insurance coverage. If they take jobs and earn any significant amounts of money, they jeopardize their disability benefits and the insurance coverage they receive through Medicaid and Medicare.

Many people with disabilities caused by severe injuries and chronic illnesses say they could work, thanks to advances in medicine and medical technology, but do not do so because they want to keep their medical benefits under the two Government health programs.

Eight million disabled people of working age receive more than $50 billion a year in cash benefits from Social Security and Supplemental Security Income. Fewer than 1 percent of them return to work. The definition of disability is strict; people qualify for benefits only if they are so disabled that they cannot engage in any ''substantial gainful activity.''

The number of people receiving disability benefits has risen sharply in recent years -- 60 percent in the last decade. People are qualifying for benefits at younger ages and staying on the rolls longer than in the past. Federal officials have concluded that they must find ways to get more people back to work.

The President's proposals would help people with H.I.V., the virus that causes AIDS, as well as people with kidney disease, spinal cord injuries, multiple sclerosis, various types of mental illness and impairments caused by strokes and heart attacks. Medicaid, in particular, covers two items of great value to many people with disabilities: prescription drugs and the services of personal assistants or attendants, who help the disabled perform everyday activities at home or at work.

Sandra L. Thurman, director of the Office of National AIDS Policy, said the President's proposal would help many people with H.I.V. keep their Medicaid benefits while they work.

''Without prescription drugs and Medicaid coverage,'' she said, ''they might not be able to work or continue to be healthy. We're always encouraging people to move from welfare to work. But to keep people in the workplace, paying taxes and living healthy, productive lives, we need to provide a minimum amount of support to make sure that happens.''

Administration officials said the President's proposal would create several new options:

*People who lose eligibility for Social Security disability benefits because they return to work would be allowed to continue their Medicare coverage. People with disabilities often take low-paying jobs that do not offer health insurance, or they do not qualify for employer-sponsored health benefits because they work part-time.

*People with disabilities could buy Medicaid coverage even if they took jobs and earned income that disqualified them from the Supplemental Security Income program. States could set the eligibility criteria and charge premiums for such Medicaid coverage.

*States could allow ''working individuals with disabilities'' to buy Medicaid coverage even if they lost eligibility for cash benefits because of medical improvements in their conditions.

Under current law, for example, a person with severe arthritis may receive cash disability benefits and Medicaid. The Medicaid pays for therapy and a new drug that allows the person to go back to work. Although this temporary remission is mostly attributable to health care coverage, the person may lose both disability benefits and Medicaid under existing law.

An error has occurred. Please try again later.

You are already subscribed to this email.

''Many of us are unable to go to work because if we do, we will lose our Medicaid and Medicare,'' said Paul Spooner of Framingham, Mass., vice president of the National Council on Independent Living, a nonprofit group that assists people with disabilities. ''That is a risk we cannot take. Our very lives depend on the prescriptions, personal assistance, technology, therapy and medical care we receive.''

Mr. Clinton's proposal is similar to legislation drafted earlier this year by Senators James M. Jeffords, Republican of Vermont, and Edward M. Kennedy, Democrat of Massachusetts. Bob Dole, the former Senator and Republican Presidential nominee who has long been an advocate for people with disabilities, endorsed that proposal, as did Senator Charles E. Grassley, Republican of Iowa.

The bill did not reach the floor of either house. It did not encounter active opposition; time simply ran out when the Senate adjourned in October.

People who receive disability benefits are periodically re-examined to see if they still qualify, and they may lose eligibility if they have even modest amounts of earned income. Under the President's proposal, no such review could be conducted solely because of a person's work activity, and such activity could not be used as evidence that the person was no longer disabled.

Thomas E. Lowery, an employment specialist in the Illinois Department of Human Services, said the President, Mr. Jeffords and Mr. Kennedy appeared to be taking the right approach.

''For millions of people with disabilities,'' Mr. Lowery said, ''the biggest obstacle to re-entering the job market is the risk of losing health insurance. A lot of them could return to work if there was a way for them to get insurance.

''I recently had a 44-year-old client with a heart condition who received $805 a month in Social Security disability benefits. His medications cost more than $500 a month. Medicaid paid for them. But if he were to go back to work, how could he afford to pay for those medications? He didn't have enough skills to do anything but an entry-level job paying the minimum wage, a little over $800 a month.''

Administration officials and lawmakers from both parties want to find better ways of providing job training and other services to disabled people. They say people with disabilities should be able to get employment services from private organizations, as well as state agencies. Accordingly, they would issue a Federal voucher, or ticket to work, that could be used by a disabled person to pay for such services.

Representative Jim Ramstad, Republican of Minnesota, said Congress must eliminate the features of current law that discouraged people with disabilities from working. Then, he said, ''they could earn a regular paycheck, pay taxes and move off public assistance.''

One reason for the growth in the disability rolls is that Congress expanded eligibility, and court decisions have forced the Social Security Administration to liberalize the standards further, especially for people with mental impairments.

Moreover, Social Security officials have publicized the disability programs and actively sought out people who might qualify. Also, many states have encouraged people to move from state welfare programs to Supplemental Security Income, so the Federal Government would pay more of the costs.

We are continually improving the quality of our text archives. Please send feedback, error reports,
and suggestions to archive_feedback@nytimes.com.

A version of this article appears in print on November 30, 1998, on Page A00001 of the National edition with the headline: CLINTON PROPOSES AID FOR DISABLED RETURNING TO JOBS. Order Reprints|Today's Paper|Subscribe